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ខ្មែរ
Order Form
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Test Kit Information
Name or Nick Name:
Phone Number for receiving test kit:
Your age:
Your Current Gender Identity:
Select one...
Male
Female
Transgender
Rather not say
HIV Test Experience:
Select one...
Have been tested for HIV before
Never had an HIV test before
Required kit Test Type:
OraQuick (Oral Fluid)
Delivery Company: foodpanda
foodpanda
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Notification!
1. The HIVST Kit is delivered between 8:00 AM and 4:30 PM, you will receive the test kit on the same day, but after 4:30 pm, you will receive the test kit the next day.
2. For National Holidays, HIVST kit will be offered on regular weekdays.
Location Access Required:
Please ensure your device's GPS is enabled. If you're using a mobile device:
Android: Settings > Location > Enable "High Accuracy".
iOS: Settings > Privacy > Location Services > Enable.
Once enabled, try again..
Location Access Required:
Please ensure your device's GPS is enabled. If you're using a mobile device:
Android: Settings > Location > Enable "High Accuracy".
iOS: Settings > Privacy > Location Services > Enable.
Once enabled, try again..
Use Current Location
Address:
Additional information for driver:
Use Alternative Location
Please type the number, to confirm the test kit delivery: 8936
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Notification!
Our team will contact you within 2 or 3 days after you receive the test kit for additional support assistance.
(I fully understand the details of the comprehensive test and agree to accept the test kit)
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